Physicians From Italy

"Therefore, the new definition of death was not merely the result of a discussion between scientists; above all, it was the first shared bioethical statement to have a tangible impact worldwide. Indeed, brain death formed the basis for the development of transplant medicine as we know it today; it enabled organ donation and harvesting from donors whose hearts were still beating. And it is thanks to that work that, today, tens of thousands of organ transplants are performed worldwide each year, and that, thanks to this treatment, countless patients who would otherwise be facing certain death are saved. Therefore, the definition of death is based on scientific certainties that there is no reason to question. Moreover, it is clear that if a doctor had the slightest doubt about a person's death, they would never proceed with organ harvesting."

"In the USA, I have always refused to perform transplants from altruistic donors, although such transplants were carried out, albeit rarely, at the centres I have managed. On the other hand, I have always supported, performed and encouraged transplants from living donors with whom there is an emotional bond. I am not convinced that it is right to subject someone who is not related to the recipient to the risk of surgery. I wouldn't go so far as to ban them, but I'm not convinced that they are an ethical approach or a solution to the appallingly long waiting lists, especially for kidney transplants."

"I said that five years ago, the then mayor, (Gianni Alemanno) , ran for office with a campaign focused on the issue of security. He had a vision of a film, the 'sheriff mayor' film, but it turned into a different film, the 'all talk and no action' sheriff film."

"While it is true that, in the US, one person dies every minute due to a shortage of organs for transplantation and that the country needs to find a solution to this pressing issue, it is also essential to safeguard the rights and wishes of individuals who, while still mentally competent, have considered the sensitive question of how they wish to be cared for (or not cared for) in the final stages of their lives and how they wish their body to be disposed of. The new measures have received enthusiastic support from a large part of the US transplant community, despite bioethics experts warning of the risk that the law could turn individuals who would not have wished to do so into organ donors, force certain family members to accept decisions they do not agree with, and even encourage doctors not to administer certain medications to terminally ill patients for fear of damaging the quality of organs that would otherwise be available for harvesting and transplantation. These concerns may be exaggerated, but they are entirely legitimate. For decades, efforts have been made to close the gap between organ demand and supply, but this does not mean that we should not proceed with the utmost caution. It may seem obvious to point out a fundamental principle, but we must always bear in mind that it is not acceptable to place more value on one life than on another – in this case, on the life of a man or woman on the transplant waiting list than on the life of a person who is nearing the end of their life on an intensive care unit. We must act with caution, demonstrating that the ultimate concern is always, and only, the respect and health of citizens, at whatever stage of life they are, at whatever age, and in whatever situation."

"Indeed, throughout human history, the end of life has always coincided with the cessation of the heartbeat: every hero worthy of the name has died because their heart stopped beating. Literature, works of art, and old medical textbooks provide ample evidence of this. [...] With the first cardiac surgery procedures and the invention of extracorporeal circulation, it became clear that the function of the heart could be replaced by an artificial mechanism: the person continued to live without a beating heart in his chest, as long as blood continued to flow to their brain. Doctors had recorded numerous signs, and the idea that the brain played a crucial role in human life was already well established. Based on these assumptions, a debate developed at Harvard that brought together not only doctors but also lawyers, philosophers and representatives of different faiths, as the aim was to find a definition of death that took into account the ethical concerns and the context at a given point in history. Since the Harvard guidelines, death is certified when all vital brain functions have irreversibly ceased."

"Some people currently argue that the definition of death should be revised in light of the technological innovations that have transformed the world of medicine. Personally, I believe that the way in which the end of life is defined is scientifically correct. More importantly, however, I believe that if anyone has doubts, they should raise them in the appropriate forums and present the scientific arguments that support their position to everyone. Otherwise, suggesting that an individual who has hitherto been defined as dead is no longer dead is an irresponsible act that risks jeopardising the opportunity to save hundreds of thousands of lives through post-mortem organ donation, a generous act motivated solely by a sense of solidarity between human beings."

"The monster is a man of remarkable intelligence and culture, of remarkable ability, who may also have done something to throw investigators off the trail."

"(About q:it:Angelo Izzo) The meritorious law should apply to those of sound mind. In 1980, I said that he would kill again and that he had to be prevented from doing so. Then he pretended to repent, making delusional statements. Because of him, we may have two more victims, who died like those in Circeo."

"The identikit [of the Monster of Florence] was that of a person of good socio-cultural standing, unlike Pacciani, who was a farmer, uncouth, uneducated, intelligent, cunning but certainly not of high standing, or of average socio-cultural standing."

"The Monster of Florence is still alive and his human trophies are in a house"

"I knew Pacciani personally, I was his defence counsel, and I will never believe that Pacciani is guilty."

"One will see a layer of smooth stones, popularly called fluitati [diluvium], and over these another layer of smaller pebbles, thirdly sand, and finally earth, and you will see this repeatedly...up to the summit of the Mountain. This clearly shows that the order has been caused by many floods, not just one."

"Many have observed and many still expect to observe, but not everyone has observed well, and others do not know how to observe, nor perhaps do they know how tricky the art of observation is, easily misunderstanding one thing for another, being blinded by the light, or not looking with due attention and diligence at what is to be looked at."

"I struggle to bear the constant "SISTER"...; I was very keen on the lay character of our group because it is LAY, even if consecrated to God: it is my personal vocation."

"Et sumpto baculo, alterum illi dedi, inquiens, volo nunc pugnemus, uter nostrum femoralia ferre debet."

"The time has now come for choices between a messianism that keeps hope alive, which kindles the Jews by motivating them daily to efforts and sacrifices, such as the building of a culture which is adapted to a better society – not the best that utopian fantasy can imagine – and a messianism that is only a camoflauge for intransigent politics, which finds its very best allies in the fundamentalists of the Arab-Islamic world, who are its mirror image."

"In order to uproot all spirit of opposition I believe it is fundamental to implement a broad educational endeavor, because certain prejudices of the Western world cannot be addressed in a few hours."

"Nel mondo reale il pericolo principale non è rappresentato dalle forze della natura, ma [...] dalla violenza dell'attuale globalizzazione neoliberista. Anzi la natura stessa è vittima di questo processo se è vero, come ricorda il biologo Edward O. Wilson, che le specie stanno scomparendo con una velocità di tre all'ora."

"Il ragazzo morto non era uno dei nostri, era un black block."

"Fruit and vegetables, instead, are foods extremely low in fats and high in fiber: by easing the passage of ingested food, they reduce the time of contact between possible carcinogens—present in our daily diet—with the walls of the intestines."

"We have to consider that the foods we ingest let a certain amount of soluble toxic substances dispersed in the environment into our bodies. These polluting substances are harmful if we breathe them in, but they are even more so if we ingest them. By consuming meat, we put ourselves precisely in that position, because such substances in the atmosphere fall back to Earth, and hence, onto the grass that, when eaten by cattle, introduces harmful substances into their adipose deposits and therefore into their flesh, and finally, onto our plates."

"It should be remembered that the pharmacologic treatment of raised farm animals can cause damage to the health of anyone who eats their meat. For example, the antibiotics that are legally added to animal feed—with the objective of preventing infections—can cause a resistance to antibiotics in humans. That is to say, a selection of bacterial strains resistant to antibiotics can be transmitted from animals to man through food; and can thereby generate infections difficult to stop (at times fatal, as with salmonella)."

"A vegetarian diet, by reason of its low content of saturated fatty acids, cholesterol, and animal proteins, and its high concentrations of folic acids, antioxidants, and phytoestrogens—shown to be effective in inhibiting the growth or in promoting the regression of serious coronary pathologies—constitutes a barrier against a number of chronic degenerative diseases, cancer among them. And that is not all. Fruits and vegetables—besides contaminating us much less than some other foods—are troves of precious substances that enable the neutralization of carcinogenic agents and that 'dilute' the concentration of diseased cells and reduce their proliferation. All of these advantages, as well as many others, emerged from studies on populations in the last century."

"Prevention is within reach of everyone. And here are recommendations: abstain from smoking, eat less, eat mostly vegetarian foods, an active mind and body, and follow individually designed early diagnostic regimens."

"We have reached the conclusion that what we eat is responsible for a large number of tumors, and that certain foods trigger cancer while others have a protective value. Meat and its derivatives figure among carcinogenic foods of the intestines. Meat, in fact, is particularly rich in saturated fatty acids, substances that lead to damaging activity in regard to our bodies in general. Furthermore, certain forms of tumors, such as intestinal cancer, are directly correlated to the consumption of meat, while others, such as endometrial tumors, are linked to obesity."

"I have declared war on pain."

"The proper management of pain remains, after all, the most important obligation, the main objective, and the crowning achievement of every physician."

"Bonica... was the first to treat pain as a disease all its own, using the multiple disciplines of neurology, orthopedics, psychology, and physical therapy, along with alternative therapies such as acupuncture. I was captivated by Bonica's ability to successfully treat a multitude of patients whose pain had previously confounded doctors for years. His book revealed how, with dedication and the proper tools, pain could be eiliminated, even if the primary illness remained. This was revolutionary in the 1940s, and it was still considered revolutionary, fifty years later."

"Anesthesiologist John Bonica faced one of those life-threatening scenarios when his wife, Emma, gave birth to their first child in 1943. Aware that anesthesiologists avoided obstetrics, Bonica personally trained the chief obstetric resident at St. Vincent's in New York in anticipation of Emma's labor. When she was ready to deliver, the chief resident was performing a cesarean section. ...To his dismay, Bonica discovered that the obstetrician wanted to avoid anesthesia. ...But even this wary doctor believed that a small amount of ether was necessary... The nervous intern... administered too much ether too quickly. ...Bonica pushed the intern aside and stepped in to save the lives of his wife and baby. From that unsettling moment on, the development of safe obstetric anesthesia was all-important to Bonica."

"He became the first anesthesiologist to experiment with the segmental epidural; he pinpointed exactly which portion of the spine needed to be anesthetized during labor... He became an outspoken advocate for expertise in obstetric anesthesiology, complaining in the Journal of the American Medical Association in 1985 that it was an old custom to assign the least experienced anesthetist and the most antiquated equipment to the maternity ward. ...he observed that interns, residents, and nurses with no training were often ordered to administer anesthesia in delivery rooms at the last minute, a situation that would never be tolerated in the operating room. Bonica urged the creation of twenty-four-hour anesthesia services dedicated to maternity wards, unheard of then, but fairly routine today."

"The crucial role of psychological and environmental factors in causing pain in a significant number of patients only recently received attention. As a consequence, there has emerged a sketch plan of pain apparatus with its receptors, conducting fibers, and its standard function which is to be applicable to all circumstances. But... in doing so, medicine has overlooked the fact that the activity of this apparatus is subject to the a constantly changing influence of the mind."

"John Bonica, himself an army surgeon during World War II, recognized the gross inadequacy of managing war injuries and other painful states of veterans with the existing unidisciplinary approaches. This led him to propose the concept of multidisciplinary, multimodal management of chronic pain, including behavioral evaluation and treatment. Bonica also highlighted the fact that pain of all kinds was being undertreated; his work had born fruit in that he is considered the "father of pain," and he was the catalyst for the formation of many established national and international pain organizations. ...As a result of his work, the American Pain Society (APS) and the International Association for the Study of Pain (IASP) have been formed, are still active, and continue to lead in pain research and pain management. Bonica's lasting legacy is The Management of Pain..."

"Bonica's years of wrestling caught up to him. ...Still in his mid-50s, he suffered severe osteoarthritis. Over the next 20 years he'd have 22 surgeries, including four spine operations, and hip replacement after hip replacement. He could barely raise his arm, turn his neck. He needed aluminum crutches to walk. His friends and former students became his doctors. ... Already a workaholic, he worked even more -- 15- to 18-hour days. Healing others became more than just his job, it was his own most effective form of relief."

"The first pain management systems were set up in the 1940s and 1950s and initially focused on chronic pain and palliative care in the UK. Although palliative care services dealt with more than pain they did bring to bear a whole systems approach to the problems which eventually influenced other types of pain management services. Both these services were led by charismatic figures, such as Dame Cicely Saunders in the UK and Dr John Bonica in the USA, who advocated a multidisciplinary and multiprofessional approach to pain management. However, the reality was that historically these service arose locally out of special interest rather than any coherent strategic planning."

"Willard Fordyce, working with physician John Bonica, reconceptualized subjective ( and therefore unreachable) "pain" into observable and measurable "pain behaviors," and showed that these respond to reinforcement contingencies just like all other behaviors. Fordyce and Bonica's program at the University of Washington was the first modern, interdisciplinary, and effective pain clinic."

"The practice of pain rehabilitation increasingly developed during the twentieth century by evolving medical specialties of physical medicine and rehabiltitation, anesthesia, psychiatry, and occupational medicine. John Bonica, one of the fathers of pain medicine, championed a more comprehensive biopsychosocial multidisciplinary approach in the United States in 1947. This approach expanded to include a team of clinicians at the University of Washington in the 1960s. Bonica's collaboration with Wilbert Fordyce, a psychologist, incorporated operant conditioning and other behavioral approaches with more specialized, structured, and in-patient multi-week programs. In the 1980s, John Loeser formalized a more structured program at the University of Washington. This 3-week long, daily program became a model for interdisciplinary treatment."

"Dr. John Bonica and I became good friends quickly, a great benefit to me then and much more later. ...John seemed to take an interest in my having trained in the surgery of children and in two weeks taught me many basic principles of anesthesiology. Little did I know at the time how useful this information would be for me—when I became chief of anesthesia at a hospital army unit in a strange country."

"John Bonica, the indefatigable champion of the multidisciplinarity of pain, took heart at the new interest generated by the gate control method. Since 1960, he had influenced a generation of young anesthesiologists, who were trained as fellows at the University of Washington... He also collected the names of researchers and clinicians interested in pain and had begun correspondences with many of them. Between 1969 and 1975, this evangelical work bore fruit, when Bonica was invited by the Japanese Ministry of Health and by corresponding agencies in several European and Latin American nations to consult on the development of pain clinics and facilities. In May, 1973, he brought 350 pain researchers together in the Seattle suburb of Issaquah for 3 days of papers and discussion and gained the group's approval to launch an international, interdisciplinary professional organization devoted to pain research and management. The International Association for the Study of Pain (IASP) was formally incorporated the following year, and the first issue of the journal, Pain... was sent to members in January 1975."

"John Bonica was an anesthesiologist and is recognized as the father of pain management, a field that has now evolved into the well-recognized medical specialty called Pain Medicine. After completing residency in 1944, Bonica joined the United States Army and was appointed Chief of Anesthesiology at Michigan Army Medical Center in Fort Lewis, Washington. For the next three years, he gained first hand experience while treating painful injuries in World War II veterans. As an anesthesiologist, Bonica found that the tools at his disposal, opioid analgesics and peripheral nerve blocks using local anesthetics, were just a small part of what was needed to adequately diagnose and treat patients with complex, chronic painful disorders. He went on to pioneer the concept of bringing multiple medial specialists together to evaluate patients and and construct a comprehensive treatment plan for each patient. Thus, the multidisciplinary approach to pain management was born."

"The full array of nociceptors is now deluging the nervous system with a blitz of chemical and electrical signals that the late American pain-management pioneer John Bonica called "the inflammatory soup of prostaglandins, protons, serotonin, histamine, bradykinin, pourines, cytokines, eicosanoids, and neuropeptides. Pain now echoes and amplifies itself as nociceptors form circuits and feedback loops, each link in the chain stimulating its neighbors to greater activity."

"John J. Bonica... recognized during his experience in World War II that he was unable to provide adequate pain relief for many of his patients if he utilized only the methods afforded to him by his training in anesthesiology. He realized that health care providers who had been trained in other specialties and had managed pain for their patients could add a new dimension to both the evaluation and treatment of complex pain conditions that did not respond to his particular treatment. Although perceived by some to be more complicated and more costly because of the intitial multispecialty evaluations and treatments, multidisciplinary team management of pain has proven to be more effective and less costly overall than when pain is managed by different specialists working independently."

"John Bonica formalized the recognition of pain as a clinical entity; the work emphasized the pain syndrome's individualized consideration, as opposed to it being thought of as little more than an accompaniment of acute trauma, or an even worse myth, the miserable complaints of neurotic patients who stubbornly refuse to heal. Bonica's formal conceptualization of pain as a disease state within its own right stimulated an ever widening wave of research and clinical application culminating in the newest specialty recognized in Medicine..."

"It was a summer day in 1941. The circus had just arrived in the tiny town of Brookfield, New York. Spectators flocked to see the wire-walkers, the tramp clowns -- if they were lucky, the human cannonball. They also came to see the strongman, Johnny "Bull" Walker, a brawny bully who'd pin you for a dollar. ...Now, the strongman hadn't told anyone, but he was actually a third-year medical student. He toured with the circus during summers to pay tuition ...over the next five decades, he'd draw on these dueling identities to forge a whole new way to think about pain. It would change modern medicine; so much so, that decades later, Time magazine would call him pain relief's founding father."

"Right around D-Day, Bonica showed up to Madigan Army Medical Center, near Tacoma. At 7,700 beds, it was one of the largest army hospitals in America. Bonica was in charge of all pain control there. He was only 27. ... Bonica tracked down all the specialists at his hospital -- surgeons, neurologists, psychiatrists, others. And he tried to get their opinions on his patients. It took too long, so he started organizing group meetings over lunch. It would be like a tag team of specialists going up against the patient's pain. No one had ever focused on pain this way before."

"It has been thirty years since John Bonica, the great anesthesia-based pain educator, expressed concern that pain was not well controlled because of the failure of physicians to apply available knowledge."

"In 1946, Dr. John Bonica began the first multidisciplinary pain center in Tacoma, Washington, based out of a private practice. It arose from his recognition that chronic pain was optimally treated by a team of specialists. For the first time, patients suffering pain were routinely evaluated by different medical specialties, physical therapists, and psychiatrists. ...Other multidisciplinary pain programs began to emerge around the country, carrying forward the original Bonica model."

"Pioneering pain researcher John J. Bonica (1990) believed that being rewarded for pain behaviors is a key factor that transforms acute pain into chronic pain. According to Bonica, people who receive attention, sympathy, relief from normal responsibilities, and disability compensation for their injuries and pain behaviors are more likely to develop chronic pain than are people who have similar injury but receive fewer rewards. Consistent with Bonica's hypothesis, headache patients report more pain behaviors and greater pain intensity when their spouses or significant others respond to pain complaints with seemingly helpful responses, such as taking over chores, turning on the television, or encouraging the patient to rest (Pence, Thorn. Jensen & Romano, 2008)"

"The practical turn in modern pain therapy is primarily traced back to American anesthesiologist John Bonica. In the early 1950s, he first tried to found the management of pain on the methods of regional anaesthesia. In 1953, he published a book... Focusing on regional anaesthesia, it was intended to list all known options for treating pain. ...regional anaesthesia alone is not the way to obtain regular therapeutic success in cases of chronic pain. However... it started a move toward detachment from the components of cultural theories that, while suitable for wordy explorations of chronic pain, only considered the statements of patients in a distanced manner, in practice leaving the patients to themselves with their pain."

"It is... with perfect timing that Dr. Dermot Fitzgibbon... with the collaboration of Dr. John D. Loeser... have provided us with a comprehensive interdisciplinary, patient-centered, guide to the assessment, diagnosis, and management of cancer pain. With a combined experience of over 50 years in pain management and in the spirit of Dr. John Bonica, both Drs, Fitzgibbon and Loeser have composed a detailed treatise that covers not only pain (with a lower case p) as a symptom, but also Pain (with a capital P), as a disease, with all its physiologic, pathologic, emotional, social, and existential dimensions."

"Dr. John Bonica, professor of anesthesiology at the University of Washington and founder of the Multidisplinary Pain Center, Seattle, spearheaded the movement to recognize pain as an entity unto itself. Bonica and other pain specialists are alarmed by an epidemic of pain throughout the industrialized world. ...He estimates that pain results in the loss of some 700 million workdays a year—in litigation, in compensation, and, mostly, in search for relief."